Additional data are needed to settle this issue. We agree with Chastre et al that the determination of the percentage of BAL-recovered cells containing intracellular bacteria is a reliable method for the rapid diagnosis of nosocomial pneumonia. The count of ICs in BAL fluid allows a rapid (<2 h) and accurate diagnosis of VAP. This technique allows a sensitive and specific means for early and rapid diagnosis of pneumonia and allows specific treatment of most patients.It is possible to define a cutoff value of these ICs with an ROC curve: 2% in our study, with a sensitivity of 84% and a specificity of 80%. Recendy, Timsit et al proposed the same cutoff (2%) with a sensitivity of 74% and a specificity of 94%.
In our opinion, the determination of ICs in BAL fluid may be considered as the reference method for the early diagnosis of VAP. Following the results of the study, except in case of septic shock, we have decided to institute empirical antibiotic therapy only in those patients who had more than 2% of ICs.